Another warning failure for our country, this time enterovirus D68, which is currently inundating pediatric intensive care units at an alarming, "unprecedented" rate. While CDC is engaged in the investigation, we thank the Missouri Department of Health & Senior Services for alerting the country and providing guidance regarding clinical care for these patients.
Grossly unusual respiratory disease, especially of the sort to place children unexpectedly and abruptly in a pediatric intensive care unit (PICU) at a level that threatens the entire PICU grid of a major metropolitan area such as St Louis demands a maximum effort to alert all healthcare providers who have a role in pediatric medicine. The emphasis of warning, being on primary care, emergency department, and intensive care unit specialties. The parents of the currently effected communities should be placed on alert as well given the apparent rapidity of clinical deterioration of these previously well children.
Some might say, "but this is (just) enterovirus D68, not a pandemic." And they would be correct. However the evidence suggests this is a rapidly moving epidemic capable of inundating pediatric medical infrastructures to the level of the PICU, which may challenge any city medical infrastructure if this challenge is juxtapositioned with a mass casualty event.
The Department of Homeland Security supposedly is responsible for the protection of our country's infrastructure. Yet, we see no notice from the National Biosurveillance Integration Center (NBIC). The Department of Health and Human Services, via CDC and under the relatively new HSPD-21, supposedly has a lead role in "medical preparedness".
We are aware of a Health Alert Network (HAN) advisory issued on 8/29 to state public health departments. However, if you ask the typical physician in America, you will find they first heard of this issue via CNN or Fox News.
While public health carries the lead for forensic, after-the-fact outbreak investigation in this country, it is the physicians who have the primary point of contact with managing our patients and the infrastructure within which they are treated. And they should be immediately in-the-know from a credible source of information (i.e. not CNN or Fox News). One would ask that, after everything this country has been through, from HIV/AIDS to MDR-TB to West Nile to Amerithrax to SARS to pandemic H1N1 to MERS to the current Ebola disaster, "Why does this country not have an effective warning system for infectious disease?"
Time to get real in this country and have better leadership than what we have now. The hubris that resists change needs to step aside.
... Meanwhile, Ebola may yet prove to be the torpedo that finally strikes this country's hull, thanks to poor response by the international community...